For Disabled People, the Elderly and their Carers in the UK

Counselling - Talking Therapy - A Guide

Counselling is a type of talking therapy where people talk to a counsellor
about their
problems. Counsellors are trained to listen sympathetically and can help
people deal with any negative thoughts and feelings that they have.

Introduction

As well as counselling, there are a number of other types of
talking therapies. For example, cognitive behavioural therapy (CBT)
is a type of talking therapy that can be used to retrain a person’s
way of thinking to help them cope with stressful situations.

NICE recommendations

The National Institute for Health and Clinical Excellence (NICE) recommends
certain types of talking therapies for treating a number of
different health conditions.

For example, counselling may be helpful in treating:

depression,

anxiety,

obsessive compulsive disorder (OCD),

post-traumatic stress disorder (PTSD),

long-term illnesses,

eating disorders, such as anorexia nervosa and bulimia, and

substance abuse.

The aims of counselling

Counselling can help people to:

discuss their problems honestly and openly,

deal with issues that are preventing them from achieving their goals
and ambitions, and

have a more positive outlook on life.

Everyone has different ways of coping with their personal difficulties.
People often deal with stressful situations and events by talking to
their partner, a family member or a friend. However, in certain situations,
talking to a professional counsellor may be more helpful.

Admitting you need help is a positive step

At some stage, you will probably experience feelings of stress,
disappointment and grief. At these times, seeking assistance can help
you deal with your feelings and emotions.

Counselling can be a positive way of addressing any unresolved issues
that you have. It can help you to understand your problems better, rather
than ignoring them and hoping that they will go away, only for them
to come back later. It can also give you a better understanding
of other people's points of view.

Talking therapies

There are a number of different types of talking therapies. Each type
aims to help people deal with negative thoughts and feelings, and
enables them to make positive changes.

The main types of talking therapies are:

cognitive behavioural therapy (CBT),

psychodynamic therapy,

humanistic therapy, and

other types of talking therapies, such as group therapy and relationship
therapy.

These therapies are discussed in more detail below.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a form of psychotherapy that may retrain
a person’s way of thinking to help them to deal with stressful
situations.

CBT is used to help solve a number of problems such as:

depression,

anxiety,

obsessive compulsive disorder (OCD),

post-traumatic stress disorder (PTSD),

managing long-term illness,

eating disorders, and

schizophrenia.

The National Institute for Health and Clinical Excellence (NICE) recommends
CBT for all of these.

CBT was developed from two earlier types of psychotherapy:

Cognitive therapy: designed to change a person’s thoughts,
beliefs, attitudes and expectations.

Behavioural therapy: designed to change a person's actions.

CBT is a talking therapy that is based around the idea that the way
a person thinks about a situation affects the way that they act. In
turn, a person’s actions influence the way they think and feel.
It is therefore necessary to change both the act of thinking (cognition)
and behaviour at the same time.

The NHS is using CBT more frequently, particularly for treating common
conditions, such as depression and anxiety. CBT courses are usually
short-term, for example, between six and 24 one-hour sessions.

See Useful links for more information about cognitive behavioural
therapy.

Psychodynamic therapy

During psychodynamic therapy, a therapist will help a person consider
how their personality and life experiences influence their current thoughts,
feelings, relationships and behaviour. This understanding enables them
to deal with difficult situations more successfully.

Psychodynamic therapy can be used to help treat:

depression,

anxiety,

post-traumatic stress disorder (PTSD),

long-term physical health problems,

eating disorders, and

addictions.

NICE recommends psychodynamic therapy for people with depression and
other complex illnesses. Psychodynamic therapy is available privately
and on the NHS in some areas. It usually lasts between several months
and several years, but shorter courses are also available.

Humanistic therapy

Humanistic therapies take a holistic approach to a person’s
problem in order to help them develop to their full potential and live
life to the full.

To achieve this, humanistic therapies incorporate the body, mind,
emotions, behaviour and spirituality. In addressing the problem, they
also look at other people, including family, friends, society and culture.

Humanistic therapies are often used to treat problems such as depression,
anxiety and addiction. NICE recommends this type of therapy for children
and young people with mild depression, and for some cases of schizophrenia.

Humanistic therapies are available both privately and on the NHS and,
depending on the problem, can be either short- or long-term, although
they usually last for at least several months.

Other talking therapies

Group therapy

The aim of group therapy is to help people find solutions to their
problems by discussing them in a group setting. Sessions are led by
a facilitator who helps by directing the flow of conversation.

NICE recommends group therapy for people with obsessive compulsive
disorder (OCD), and for children and young people with mild depression.

Relationship and family therapy

Relationship therapy is where couples who are having difficulties
in their relationship work with a therapist to try to resolve their
problems. Family therapy is similar but involves a therapist working
with a family that is having problems.

NICE recommends relationship therapy for people who have tried individual
therapy without success, and family therapy is recommended for children
with depression, or where a family member has a condition such as anorexia
nervosa or schizophrenia.

Interpersonal therapy

Interpersonal therapy focuses on how a person’s mood can influence
the way that they relate to others who are close to them. NICE recommends
this type of counselling for people with eating disorders and depression.

Mindfulness-based therapies

Mindfulness-based therapies combine talking therapies with meditation.
They are used to make positive changes by helping a person
to reduce stress and cope with problematic thoughts and feelings.
NICE recommends this type of therapy to help people avoid repeated
bouts of depression.

Eye movement desensitisation and reprocessing
(EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a treatment
method that uses eye movements to stimulate the brain. EMDR has been
shown to make distressing memories feel less intense.

EMDR can be used to treat a number of traumas, such as addictions,
accidents and injuries, phobias, and sexual, physical or emotional abuse.
NICE recommends EMDR for post-traumatic stress disorder (PTSD).

Motivational counselling

Motivational counselling involves talking about issues and problems
that could prevent a person from achieving their goals
and ambitions. NICE recommends this type of counselling for people who
have a mental health problem, or a problem with alcohol or substance
misuse.

Telephone counselling

Telephone counselling, such as the service provided by the Samaritans,
enables you to talk to a therapist without having to meet them face-to-face.
It may be available through charities or your employer. Alternatively,
you may be able to receive counselling by email or on the internet.

How counselling works

Counselling can help you deal with a range of issues, from day-to-day
worries or concerns to more serious, long-term psychological problems.

Counselling can help you come to terms with distressing or traumatic
events, such as the loss of a loved one, divorce, or confusion about
your identity or sexual orientation. It can also be an effective way
of dealing with long-term mental health problems, such as depression
and anxiety.

How can a counsellor help?

A counsellor is someone who is trained to listen sympathetically to
your problems and can suggest strategies that will help you to resolve
issues and change your behaviour.

By discussing your concerns with you, the counsellor will be able
to help you gain a better understanding of your feelings and actions,
as well as suggesting ways for you to find your own solutions to
your problems.

The counsellor may encourage you to identify issues more easily and
take personal responsibility where appropriate. They can help you to
recognise the effect of other people and their actions, and to explore
alternative ways of coping.

It can be a great relief to be able to share your worries and fears
with someone who will confirm your feelings and help you to reach a
positive solution.

Counselling can take a range of different
formats

There are many different types of counselling that are available in
a range of different formats. Counselling can take place:

face-to-face,

over the telephone, or

by email.

You may be offered counselling as a single session, as a short-term
course of sessions for a few weeks or months, or as a long-term arrangement
that lasts for many months or years.

See Types of counselling to find out more about the different types
of counselling that are available, and the conditions for which they
are recommended.

Where to get counselling

Counselling on the NHS

Your GP or another healthcare professional may refer you to a qualified
counsellor. In this situation, you will receive counselling through
the NHS free of charge. In some areas, the choice of counsellors may
be limited and there may be long waiting lists.

In England and Wales, many GP surgeries employ counsellors. If your
GP surgery does not offer a counselling service, you may want to ask
your GP about counselling as a possible treatment option.

The National Institute for Health and Clinical Excellence (NICE) provides
recommendations about the therapies that should be prescribed for certain
health conditions. See Types of counselling for more details.

For certain conditions, it may be possible to get some types of therapy
on the NHS. For other conditions, it may be more difficult.

Private counselling

Certain types of counselling may not be available on the NHS. For
example, some types of psychotherapy may only available from appropriate
professionals, such as psychotherapists.

Therefore, you may need (or decide) to seek private counselling. The
cost of private counselling can vary considerably. A session can cost
between £20 and £100 an hour.

Charities and voluntary organisations

Some charities and independent voluntary organisations may offer counselling.
These organisations will usually specialise in a particular type of
treatment or skill area such as bereavement, marriage counselling or
family guidance.

You may also be able to access support groups through your local church,
social services or local community.

Trusting your counsellor

A good counsellor will focus on you and listen to your problems without
judging or criticising you. They may provide you with advice about strategies
that can help you to deal with your problems, but they should not tell
you what to do.

For counselling to be effective, you need to build up a trusting relationship
with your counsellor.

If you feel that you and your counsellor are not seeing eye to eye,
or if you feel that you are not getting the most from your counselling
sessions, discuss this with your counsellor. If the situation does not
improve, it is perfectly acceptable for you to look for another counsellor
who you feel more comfortable with.

If you are currently seeing the NHS counsellor who is attached to your
GP surgery, your GP may be able to arrange for you to see another NHS
counsellor. Or you may choose to pay to see a private counsellor.